Bypass Surgery, Stents Seem to Bring Same Level of
WEDNESDAY, March 16 (HealthDay News) -- New research suggests
that certain heart patients will fare about the same whether they
have heart bypass surgery or a less-invasive procedure that uses
drug-coated stents to prop open clogged arteries.
The findings may boost the appeal of stent procedures, which
also require much less recovery time. However, patients with the
most severe disease did do better with bypass surgery.
Regardless of whether a patient with chest pain undergoes a
bypass or stent operation, "the message is that they can feel
comfortable" with their decision, said study author Dr. David J.
Cohen, director of cardiovascular research at Saint Luke's Mid
America Heart Institute in Kansas City, Mo. "The degree of symptom
relief is very comparable."
The vast majority of patients with coronary artery disease --
about 90 percent -- "do just fine" when they take medications to
combat their clogged arteries, said Dr. Kirk N. Garratt, associate
director of the division of cardiac interventions at Lenox Hill
Heart and Vascular Institute in New York City. But the rest of
heart patients need an operation to stop chest pain, he noted.
Bypass operations used to be the standard treatment, but stent
operations have become more common in recent decades. Surgeons prop
open clogged vessels with stents through a procedure called an
angioplasty, and patients typically recover within days instead of
weeks or months.
The problem, Garratt said, is that the body tries to heal the
injury after the operation with scar tissue that can be harmful.
Over the last decade, however, stents have started to come with
drug coatings that discourage scar tissue from forming.
The new study, funded by stent manufacturer Boston Scientific
Inc., aimed to determine how patients fared in terms of quality of
life after getting bypasses or treatments with stents.
The researchers randomly assigned 1,800 heart patients to
undergo either bypass surgery or a stent procedure. These patients
had either three-vessel or left main coronary artery disease. The
study authors followed up six and 12 months later to see how the
patients were doing.
At a year, 76 percent of bypass patients said they were free of
chest pain, also known as angina; 72 percent of stent patients said
they were, according to the report.
"I'm not sure that this is earthshaking," said Garratt. "It was a fully predictable finding, considering what we already knew."
There are other factors for patients to think about before
getting an operation. Stent patients face a higher need for repeat
operations than bypass patients, Cohen noted. "If a patient has a
strong aversion to coming back, a bypass operation is going to be
more durable. It will last longer and keep them out of the hospital
And patients with the most complex cases will fare better --
both in terms of quality of life and lifespan -- after a bypass,
In general, though, "if you're one of the unlucky few that need
more than medicine to take care of your heart disease, both surgery
and angioplasty promise to give you excellent results," Garratt
They won't necessarily help you live longer, however. Neither
procedure has been shown to boost lifespan by a meaningful amount,
Garratt said, except for heart attack patients. "What they add," he
said, "is quality of life."
The findings are published in the March 17 issue of the
New England Journal of Medicine.
For more about heart disease, try the
U.S. National Library of Medicine.
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